胆胰分流术使糖尿病人长期获益

Biliopancreatic Diversion Has Lasting Benefits in Diabetes

胆胰分流术使糖尿病人长期获益

NEW YORK (Reuters Health) Feb 10 - In morbidly obese patients with newly diagnosed type 2 diabetes, biliopancreatic diversion (BPD) significantly reduces renal and cardiovascular complications over 10 years, according to new research.

纽约（路透社）2月10日----根据新的研究，在新诊断的重度肥胖的2型糖尿病患者，胆胰分流术（BPD）显著降低10年肾脏和心血管并发症，。

A recent meta-analysis found that type 2 diabetes resolves in the majority of patients after bariatric surgery, with BPD and duodenal switch providing the greatest effect.

最近的一项荟萃分析发现，大多数患者在减肥手术以后2型糖尿病也已治愈，胆胰分流术和十二指肠吻合手术的效果最好。

But there are not a lot of data on the long term benefit, said Dr. Geltrude Mingrone, from Catholic University in Rome, Italy and colleagues. In the January 31 online issue of Diabetes Care, they report on 50 obese patients (body mass index >35) with newly diagnosed diabetes who were followed for 10 years. All were treated at the Day Hospital of Metabolic Diseases in Rome with BPD or conventional medical therapy (i.e., metformin alone or with sulfonylurea or insulin).

但对于是否可长期受益数据仍然不多，罗马Catholic University的Geltrude Mingrone博士及其同事说。在1月31日糖尿病诊疗杂志在线发表的报告中，他们报告了50例新诊断的肥胖糖尿病患者（体重指数>35）随访10年的结果。所有患者在罗马Day Hospital of Metabolic Diseases接受BPD或常规药物治疗（即单独应用二甲双胍或与磺酰脲及胰岛素联合应用）。

Patients who opted for BPD had less micro- and macrovascular complications at 10 years than those treated with conventional medical therapy, they found.

他们发现，应用了胆胰分流术的患者比常规药物治疗治疗的患者10年后的微血管和大血管并发症减少。

After one year, all BPD patients were in remission from type 2 diabetes, compared with 45% in the control group (P < 0.001). None of the surgery patients had diabetes again during the remainder of follow-up. At 10 years, surgical patients had lost 34.6% of their initial weight, compared with a weight loss of 0.38% in the control group.

一年后，所有BPD患者2型糖尿病缓解，而对照组仅有45％（P<0.001）。在随后的随访中，手术患者糖尿病均未复发。10年中手术患者体重降低34.6％，而对照组体重降低仅0.38％。

The relative percentage variation in glomerular filtration rate (GFR) over 10 years was a main outcome measure. The result was significantly different between the groups (P < 0.001), with an increase of 13.6% with surgery vs a decrease of 45.7% without.

10年中肾小球滤过率（GFR）变化的相对比例是观察的主要结局。结果两组中有明显差别（P<0.001），手术组改善13.6％，而未手术组下降了45.7％。

At diagnosis of diabetes, rates of microalbuminuria were 14.3% in the control group and 31.8% in the BPD group. After two years, the rate had climbed to 28.6% in the control group and fallen to 9.1% in the BPD group. By 10 years, all BPD subjects recovered from microalbuminuria, whereas in the control group the prevalence of microalbuminuria continued to rise.

在糖尿病诊断时，微量白蛋白尿在对照组为14.3％，在BPD组为31.8％。两年后，这一比率在对照组已攀升至28.6％，而BPD组下降到9.1％。 10年后，所有BPD组的患者蛋白尿均已恢复，而对照组的微量白蛋白尿患病率持续上升。

Four patients, all in the control group, had four major events (three myocardial infarctions and a stroke).

The absence of myocardial infarction and stroke and the reduction in cardiovascular risk in the surgery group suggests that the operations "had a strong impact on abating cardiovascular disease," the investigators say.

对照组中的四名病人有4例主要事件（3例心肌梗塞和中风）。对照组中未发生心肌梗塞和中风且心血管风险下降提示手术“能够明显减低心血管疾病”研究者说。

And indeed, the estimated probability of coronary heart disease at 10 years was 0.22 in the control group versus 0.05 in the group (P < 0.001).

事实上，在第10年估计对照组冠心病的危险性是0.22，BPD 组为0.05（P<0.001）。

"Our study is the first report in the literature showing the efficacy of bariatric surgery in reducing (or better, in avoiding) the micro- and macro-vascular complications of diabetes," Dr. Mingrone told Reuters Health. "Even though the patients are well controlled pharmacologically in relation to their glycemia, as it can be shown by a glycated hemoglobin lower than 6.5%, diabetes complications are not prevented but only reduced."

“我们的研究首次表明了减肥手术在较少（或避免）糖尿病微血管和大血管并发症的作用” Mingrone博士告诉路透社记者。 “即使病人用药物控制血糖良好，即糖化血红蛋白低于6.5％，糖尿病并发症仍无法避免，只能减少。”

"Therefore, our data are particularly relevant because long-term complications of diabetes develop gradually and can eventually be disabling or even life-threatening," Dr. Mingrone noted.

“因此，我们的数据是尤为重要，因为糖尿病远期并发症逐渐发展并最终致残甚至危及生命”博士Mingrone指出。

Early complications after BPD included one pulmonary infection (4.5%) and one wound infection (4.5%); late complications included three incisional hernias (13.6%) and two peptic ulcers (9.1%).

BPD后的早期并发症包括1例肺部感染（4.5％）和一例伤口感染（4.5％）；晚期并发症包括三例切口疝（13.6％）和两例消化性溃疡（9.1％）。

The authors admit to some weaknesses of the study: a large dropout rate, lack of randomization, and a large average BMI (roughly 50). "As a result of these factors, the population studied does not represent the general population of patients with diabetes," they note.

作者承认本研究存在一些缺点：脱落率较高，缺乏随机化平均BMI较高（约50）。 “由于这些因素，这项研究人群并不能代表糖尿病患者的总人群”他们强调。

Dr. Mingrone noted that BPD is "scarcely performed in the United States, an equivalent operation might be the duodenal switch. In Europe subjects with BMI > 35 kg/m2 and type 2 diabetes are candidates."

Mingrone博士指出BPD“很少在美国进行，相似的手术或许是十二指肠吻合术。在欧洲，BMI>35 kg/m2的2型糖尿病患者常采用手术治疗。“

Diabetes Care. Posted online January 31, 2011.